Healthcare Provider Details

I. General information

NPI: 1902309131
Provider Name (Legal Business Name): REBECCA ELIZABETH ANDERSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ELIZABETH GUTIERREZ RN

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 MILNE RD NW
ALBUQUERQUE NM
87120-1691
US

IV. Provider business mailing address

4201 MEADOWLARK LN SE APT 7
ALBUQUERQUE NM
87124-1067
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-3301
  • Fax: 505-831-6314
Mailing address:
  • Phone: 505-720-9183
  • Fax: 505-831-6314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-73024
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: